Anne Schuchat

Public Health Newswire interviewed Centers for Disease Control and Prevention Acting Director Anne Schuchat, MD, on the state of public health and the agency’s plans for 2018.

What do you anticipate being the biggest public health challenges for our country in 2018?

We know that infectious disease threats, antimicrobial resistance, global health security and opioids will continue to be critical public health issues. But regardless of the nature of the threat, CDC remains committed to working 24/7 to keep America safe, healthy and secure. We will continue to conduct critical science and provide health information that protects our nation against expensive and dangerous health threats, and respond quickly when they happen.

Jerome Adams

The Nation's Health spoke with U.S. Surgeon General Jerome Adams, MD, MPH, about what he plans to accomplish. Photo courtesy EZ Event Photography.

How do you plan to uphold your promise to put science before politics as surgeon general?

As surgeon general of the United States, I think what is important is that we engage the right partners and show them how embracing health and embracing our priorities will lead to them being more prosperous, will lead to them being safer and more secure, will lead to them being able to provide for themselves and their families. And if we do that, then it’s not really putting science before politics, it’s understanding that science needs to be part of the complicated multi-variant policy equation, but that it’s one of several components. If we’re going to expect people to listen to and embrace the science, then we have to listen to and embrace their priorities.

Georges Benjamin

In 2017, police shot and killed almost 1,000 people in the U.S., according to a tracking project from The Washington Post. Julia Haskins, reporter for The Nation’s Health newspaper, interviews Georges Benjamin, MD, executive director of APHA, about the problem of police violence in the U.S., and how it affects the health of the public.

How is police violence a public health issue?

Violence, in all of its forms, is a public health issue because it impacts both physical health and mental health. It's a significant problem, because violence can lead to injury and even death and undermines both the sense of community well-being and the sense of personal well-being. And we know that like other violence, police violence is preventable.

Howard Frumkin

During the 2017 APHA Annual Meeting, Howard Frumkin, MD, DrPH, MPH, professor of Environmental and Occupational Health Sciences at the University of Washington School of Public Health, discussed the “Lancet Countdown: Tracking Progress on Health and Climate Change 2017” report, of which he is a co-author. APHA served as co-publisher of the “Lancet Countdown 2017 Report: U.S. Briefing.” Frumkin shared highlights of the report, and how public health advocates can use it today.

The countdown outlines policy-level steps that can be taken to fight climate change. Why start there?

Well, it’s really important to start at two different levels simultaneously. One is policy. At the federal and state levels, we need to do things like shift our primary energy sources, shift our transportation system and change the incentives in our food system so that all those systems can contribute less to climate change.

But it’s also important to start at the very personal and community levels. We need to shift our preferences in eating toward less meat-heavy diets. We need to shift our preferences in transportation away from gas-guzzling, single-occupancy vehicles to walking, biking and transit. We need to use less energy, insulate our houses better, use fewer resources, reuse and recycle more. All of those traditional environmental behaviors and attitudes are very important at the individual and community level, but they need to be accompanied, of course, by policy changes.

And then, of course, in the public health sector, where we are responsible for driving a lot of adaptation, protecting the public from the impacts of climate change, we need to step up and do even more than we’re doing, protecting people from disasters like floods and fires and droughts, protecting people from the expansion of infectious diseases, protecting people from expanding allergic illnesses, protecting people from respiratory hazards due to worsening air pollution.

Tom Frieden

Since stepping down as CDC director, APHA member Tom Frieden, MD, MPH, has been busy with a new global public health initiative, Resolve to Save Lives. The purpose of the initiative is twofold: Resolve to Save 100 Million Lives aims to reduce cardiovascular disease, while Resolve to Prevent Epidemics will target infectious disease epidemics. Over the course of the five-year program — funded by Bloomberg Philanthropies, the Chan Zuckerberg Initiative and the Bill & Melinda Gates Foundation — Resolve to Save Lives will implement best practices in low- and middle-income countries to curb preventable deaths. The Nation’s Health spoke with Frieden, an APHA member, about what to expect.

How will Resolve engage with local public health advocates and stakeholders to pursue improved health outcomes?

Most countries have the determination and the will to improve the health of their citizens, but may need help turning that determination into action. We’re not going to tell countries what to do, rather, we’ll help countries reach the goals they’ve already set for improving heart health or epidemic preparedness. Engagement with local public health leaders is critical to our success and the health of their country.

Molly Marti

Now more than ever, people need tools and resources to adapt to a changing climate, according to Mollie Marti, PhD, JD, president and CEO of the National Resilience Institute. Marti, an APHA member, spoke to The Nation’s Health about how climate change affects health, and what people can do to resist such harm.

What should be the public health community’s role on this issue?

I think the role on public health, and psychologists and people who are focused both on building awareness and providing education, must be on building that personal and psychosocial resilience.

Because what’s happening as we don’t have those capacities is there’s a higher level of fear. And there’s fear-based human reaction to these climate impacts, and so that’s going to decrease our ability to think clearly, it’s going to decrease our ability to work collaboratively. And all of that is going to decrease our ability to look at it with a broader perspective and see what is needed. How do we cut emissions, how do we prepare for climate impacts? And humans, when they’re in a fear response, or reaction, aren’t able to be thinking clearly and creatively and innovatively and collaboratively.

If we don’t really focus on building up this resilience base, building up this capacity, then it’s going to be a negative spiral, and that spiral can start moving more and more quickly.

Beth Bell

Beth Bell, MD, MPH, serves as director of the Centers for Disease Control and Prevention’s National Center for Emerging and Zoonotic Infectious Diseases. As its director, Bell is a leading expert in examining epidemics around the world and the public health response to them. She spoke with The Nation’s Health and gave a review of the year in diseases for 2015, as well as some insight on what the future might hold in the field.

Looking beyond Ebola, what were some of the biggest issues and outbreaks that you saw in 2015, and what did the center do to respond to those?

Last year, we saw a number of large foodborne outbreaks. In the United States we have a cluster detection system, which is based in every public health laboratory in the country, and for a foodborne illness it’s called PulseNet.

At any given time, we here at CDC are monitoring anywhere between 15 and 40 clusters that we identify based on our DNA fingerprinting methodology, and some of those turn into outbreaks, and some of them turn into large multi-state outbreaks.

This last year…we had an outbreak of listeria associated with Blue Bell ice cream. We really never had seen listeria contaminating ice cream before, and this was a very large outbreak. Listeria is a particularly deadly infection for pregnant women, immunocompromised people and elderly people, and so we always see a lot of hospitalizations, and unfortunately deaths, with listeria outbreaks.

Patricia Flatley Brennan

As director of the National Library of Medicine, Patricia Flatley Breenan, oversees the largest biomedical library in the world, with data available to both professional and lay audiences. She spoke with The Nation’s Health about the value of NLM as it enters its third century of service to the public.

Why is the National Library of Medicine so important to public health?

I think probably the most important thing is that we have a strong commitment to public health research information data. Tox Town is a repository of information about toxic exposure. We also have a resource called TOXNET, a suite of databases that has information on over 400,000 different chemicals. And we have a website for health service research and public health information programs. And this is research informally of the National Information Center for Health Services Research. NICHSR provides outside links to the health services research and public health partnerships that make it possible for a local public health community to find quick information about things such as Indian health or perhaps to provide help with training resources about toxicology. We view our partnership in public health…as being one of our critical target areas.

Jonca Bull

Jonca Bull, MD, FDA's assistant commissioner for minority health, talked with The Nation’s Health about some of the barriers to diversity in clinical trials and FDA’s efforts to spread awareness and show transparency about who is participating to inform outreach in the the future.

How diverse are U.S. clinical trials currently? Where are the biggest gaps?

I think it varies. The basic question is how much variability in terms of the disease burden, what patient characteristics are most critical that would raise the significance of diversity in a clinical trial.

Optimally, we are very interested in seeing populations, as stated in our policies, that reflect the population that use the products in the post-market environment.

There certainly are challenges. We live in a world where medical product development is a global enterprise. A real challenge for us is establishing that populations are adequately comparable so that the data that informs an approval decision is as accurate and close as possible to the population here in the U.S. will use the product.

Michael Botticelli

Michael Botticelli, MEd, might be uniquely prepared to serve as director of the U.S. Office of National Drug Control Policy: When he was sworn into the job in February this year, he had 25 years of sobriety. Botticelli has been open about his own history of alcohol abuse, and how the option for a treatment program, rather than jail, helped set his life’s course for work in public health.

How can public health advocates partner with others to reduce drug use and its consequences?

Part of our office is to really look at better integration of substance use disorders into mainstream medical care. I always say that we have bifurcated systems of care, when you get your general medical care on one side and you get your behavioral health care on another. I think that is kind of emblematic of the training that happens both in terms of (the) medical profession and in terms of public health schools. Part of what I think we’ve been trying to do and the others have been really (is) to generate a level of education and understanding on why it’s important to look at substance use disorders as part of both population health, but also individual health.

I think that there is this cultural divide about treating “those people:” that they are too disruptive, that they are too difficult to treat and incorporating them as part of overall medical care is seen as too problematic, and they can only be serviced well in a specialty treatment system. But what’s happened over really the past few years, particularly with the Affordable Care Act, is that we are seeing the kind of models as well as delivery systems that are integrating substance use disorder treatment in mainstream medical care.

Sylvia Burwell

From work championing insurance coverage under the Affordable Care Act to ensuring that U.S. children have opportunities for health, U.S. Department of Health and Human Services Secretary Sylvia Burwell has overseen a range of public health issues since she became secretary in June 2014. Burwell spoke with The Nation’s Health about how her experiences prepared her to become a leader in U.S. health.

More than 16 million Americans have gained health insurance coverage through the ACA. Where are the greatest successes?

When it comes to access, affordability and quality, the Affordable Care Act is working.

For access, we have the historic number of people who are now covered, thanks to different aspects of the law. Since the law was passed five years ago, about 16.4 million uninsured people have gained health coverage. That’s the largest reduction of the uninsured in four decades.

And that progress was made in part to the greater affordability of coverage. Nearly 80 percent of 2015 marketplace customers who selected a plan using Healthcare.gov could purchase coverage for $100 or less after tax credits. Children can stay on their parents’ plans until age 26, preventive services like screenings and well-woman visits are covered at no out-of-pocket cost and lifetime caps on coverage are a thing of the past.

Gail Christopher

Because of factors such as a history of racial discrimination, many Americans are locked into a cycle of unfavorable health outcomes and face unequal opportunities to factors that can support a better life, such as access to quality education and safe housing. The W.K. Kellogg Foundation’s Truth, Racial Healing and Transformation enterprise is creating fact-finding forums across the U.S. where people who struggle with health disparities can reach common ground. Gail Christopher, DN, vice president of the enterprise, talked with The Nation’s Health.

How does racial inequity lead to health inequity in the U.S.?

We have known for some time that there are just consistent and persistent…racial health disparities and inequities. Many of those disease conditions are directly linked to stress and key environmental factors or the social determinants of health and well-being.

Because of our residential segregation and our lack of equitable investment in communities and in neighborhoods, there is more adversity, there is more stress oftentimes that takes the form of violence.

Sometimes it takes the form of just chronic unemployment and the lack of access to resources. This translates into physiological and biochemical precursors for altered body function. The link between adversity and trauma and disease is much better known and understood today than it was 50 years ago. So there’s that sort of pre-disposition, if you will, to illness that’s aggravated by the social conditions in which people live. But there’s also a lack of access to equitable health care because of the residential segregation and the inequality that shows up on the ground with a disinvestment or patterns of disinvestment within communities.

Larry Cohen

Larry Cohen, founder and executive director of Prevention Institute, has been a public health and prevention advocate and pioneer for more than 40 years. In his latest book, “Prevention Diaries: The Practice and Pursuit of Health for All,” he explores the aspects of daily life that influence our health and argues that a prevention approach offers many common-sense solutions that save lives and money, and reduce human suffering.

APHA is a long-time partner of Prevention Institute. As APHA strives toward our strategic goal of creating the healthiest nation, how can a prevention approach lead to new ways of thinking about how to reach this goal?

We know that prevention works. We understand that health matters to everyone, but some communities have been systematically disadvantaged and affected more than others, and it’s time to build that into a system that advances prevention and equity. We understand that our bodies, our minds, and our environments need to be aligned for health. We can’t talk about asthma and ignore housing and traffic; it’s not just about getting individuals to adjust, but about ensuring safe housing and improved air quality. We can’t talk about high utilization and ignore mental health and trauma — and it’s not just about identifying individuals with adverse childhood experience but about transforming adverse community environments into healthier ones that promote resilience. It is time not only to recognize the importance of community well-being, but to fully engage and align with community. This means partnering far beyond health organizations and achieving new strategies. It means ensuring our policies and practices move our norms and environments. APHA plays a critical role in enabling new thinking and solutions to be shared, and their methodology understood. More importantly, APHA is a partner and a leader in promoting policy and practice changes across the country.

Hazel Dean

Hazel Dean, ScD, MPH, is the deputy director of the Centers for Disease Control and Prevention’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. She is widely recognized for her work in addressing disparities in HIV and sexually transmitted disease rates. With continuing disease challenges on the horizon, Dean spoke to The Nation’s Health about her top priorities, new prevention opportunities and why social media is a critical public health communication tool.

Your CDC center oversees a wide range of health issues, from multidrug-resistant TB to continuing disparities in HIV infection. What have been the most significant accomplishments?

Six particularly remarkable accomplishments, among many, come to mind. First, highly effective antiretroviral therapy has greatly extended life expectancy among people living with HIV and resulted in a dramatic drop in AIDS deaths. Additionally, consistent pre-exposure prophylaxis use now reduces HIV transmission, and considerable progress has been made in other highly effective interventions, such as male circumcision, STD treatments, antiretrovirals and vaccines. For hepatitis C, advances in antiviral treatments have helped cure infection, reduce transmission and prevent deaths. For STDs, better testing, treatments and partner management have reduced syphilis by 22 percent and gonorrhea by 34 percent among blacks. Finally, annual tuberculosis cases in the United States have reached an all-time low.

Despite these accomplishments, however, our center still has many urgent priorities, not the least of which are limiting antibiotic-resistant gonorrhea and reducing STDs among young people. We cannot claim victory yet over tuberculosis and must continue to take steps toward its elimination. While improved treatments for hepatitis C are a major step forward, there is still a great need for more widespread testing to make people aware of their infection so that they can benefit from new life-saving treatments. Progress in HIV prevention has been uneven, and gay and bisexual men and blacks continue to be most affected. We must ensure that all prevention strategies reach all populations equally.

Karen DeSalvo

More hospitals and health care facilities across the nation are making an effort to move toward more efficient care, such as adopting an electronic health records systems. Karen DeSalvo, MD, MPH, MSc, acting assistant secretary for health and national coordinator for health information technology at the U.S. Department of Health and Human Services, talked with The Nation’s Health about how recommendations in the new Federal Health IT Strategic Plan released in December will play a role in improving the quality of health care and what she sees in the nation’s future under her leadership.

You have dedicated your life to improving the health of your community. What are your goals as the acting assistant secretary of health?

We have to mobilize all the resources of public health in its forms as local and state jurisdictions, but also in the many other ways that it comes together to work for the public’s health through public health institutes, as an example, through foundations and other efforts. To really see that we’re leveraging all the resources, that we are working across sectors outside of medicine, outside of public health, into transportation and education and housing, as an example, to create safe places that are healthy where all kids can grow up and everyone can fulfill their potential. I just want to be a voice for that.

Victor Dzau

Victor Dzau, MD, has had an exciting term since assuming the presidency of the National Academy of Medicine in July 2014. For one thing, the organization was not called NAM when he came on board — its membership voted in 2015 to transform the then-Institute of Medicine into the National Academy of Medicine. Now, the independent NAM is branching even further into what it means to develop meaningful research to be used in health fields. Dzau spoke with The Nation’s Health about the future of the academy and its ongoing work.

What new NAM initiatives are you most excited about?

The one that we are very excited about…is called Vital Directions in Health and Health Care. A year ago, we were well aware that there’s going to be a change in U.S. administration. Our members, our council are saying, what would it look like under new administration? What are things that still haven’t quite been achieved? What are things that we need to think about going forward?

We convened a steering committee of 18 members, which commissioned over 100 experts to write papers, 19 in total, under the three themes: health and well-being, or health and wellness; health care delivery; and science and technology. Under those three themes are specific papers that look at life course management, social determinants of health, precision medicine, payment reform, science and technology for the future.

On Sept. 26, these reports were released by (the Journal of the American Medical Association) as what they call viewpoints. On the same day, we (had) public discussion we call a national conversation of the various Vital Directions. We can have authors and also non-authors to come and sit together and talk about what we believe are the issues that should inform the next U.S. administration and get input from the public. Following all this, we’ll have a synthesis paper that will bring together all these dialogues into one final paper, published in Perspectives and in JAMA. That’s going to happen around December.

We are thinking and hoping that this initiative will inform the next U.S. administration. Therefore, we are beginning to reach out to transition teams and to work with the next administration after the election, and begin to work with them in any fashion we can to help advise them.

Anthony Foxx

With the intersections between public health and transportation planning recognized as a key consideration in improving community health, Anthony Foxx, secretary of the U.S. Department of Transportation, spoke with The Nation’s Health about the many ways in which health and opportunity are driving the future of transportation.

Health conditions related to physical inactivity, such as obesity, heart disease and diabetes, have reached epidemic proportions in some American communities. How do you see DOT’s role in confronting our chronic disease problem?

I think this is a place where local communities are ahead of the federal government, and the federal government needs to catch up.

I was a mayor before becoming secretary of transportation, and we worked very hard to expand bicycle lanes in my city, to put together more robust sidewalk programs so people had safe places to walk. At the federal level, a lot of the resources that we do spend on pedestrian and bicycle facilities are sometimes maligned because there’s a sense that the dollars should be spent on highways or spent on other things. But when you go to any metropolitan area in this country, people are looking for ways to get out of traffic and get into a healthier way of moving around, and that’s something the federal government should be supporting.

And that’s why we launched the Safer People, Safer Streets campaign, which was our way of beginning to lean much more into this issue by providing good guidance to communities on how to design a roadway to be more accommodating to pedestrians and bicyclists. Then there’s a host of things that our Federal Highway Administration is doing. We’ve done audits in several states already to look at their pedestrian and bicycle access points and given direct feedback on how to do it better. Not only are we having an impact on the ground, we’re actually teaching our own Federal Highway Administration how to think more broadly about the connection between what they do and public health.

Tom Frieden

In his fourth annual "state of public health" address for Public Health Newswire, Centers for Disease Control and Prevention Director Tom Frieden tackles a smorgasbord of pressing health issues and shares how “The progress we achieve builds on itself to create new opportunities to improve the nation’s health and reduce disparities.”

What are CDC's greatest opportunities and challenges for 2016?

CDC and our state, tribal, local and global partners have enormous challenges in the coming year.

We need to completely extinguish Ebola in West Africa, eradicate polio in Pakistan and Afghanistan, and accelerate the work of strengthening public health infrastructure in every country so that the world will be better protected from the next threat.

We must find and stop outbreaks of drug-resistant organisms rapidly and protect antibiotics by greatly improving their rational use among both humans and feed animals.

We have to reverse the tragic and devastating opioid epidemic, particularly through improved prescribing practices for pain and addiction, and working with law enforcement to reduce the supply (and thus increase the cost) of illicit opioids.

We have to double down on efforts to prevent our two leading killers – cardiovascular disease and cancer – by intensifying implementation of comprehensive tobacco control and making even more progress in our Million Hearts campaign.

We are under pressure to keep effective programs from becoming victims of their own success. As public health historian John Duffy noted: “Encountering apathy, ignorance, and avarice is the lot of all conscientious health officers. As preventive measures in the health area are more successful, the public is less inclined to support the programs which ensure this success.”

Thanks to the Tips from Former Smokers campaign and other tobacco control efforts, for example, fewer Americans smoke than ever before. Unfortunately, this success has led to complacency. Funding for the Tips campaign is threatened, even though it is an extremely cost-effective program that saves at least 16,000 lives each year.

Even the most successful public health programs require constant evaluation, innovation, and improvement. The progress we achieve builds on itself to create new opportunities to improve the nation’s health and reduce disparities.

Tom Frieden

As he prepares to leave office, Centers for Disease Control and Prevention Director Tom Frieden shared with us his hopes for the future of public health and the challenges that still lie ahead.

What’s the outlook for public health funding given a new administration and Congress? In particular, pledges to repeal the Affordable Care Act and eliminate the Public Health and Prevention Fund would deal a blow to CDC’s budget. How do you foresee the agency’s strategy changing while continuing the progress that’s been made thus far?

Protecting American’s health, safety and security will continue to be CDC’s mission, as it has been throughout the agency’s 70 years and a dozen presidential administrations.

Whatever Congress does regarding the Affordable Care Act, public health will be as relevant – or more relevant – today than ever before. The ACA established the Prevention and Public Health Fund to provide expanded and sustained national investments in prevention and public health, to improve health outcomes and to enhance health care quality. The fund supports more than 10 percent of CDC’s total program budget, with most of these funds supporting widely supported programs at the state and local level such as the public health and social services block grant, protecting children and adults through immunization, strengthening capacity to respond to domestic infectious disease threats and preventing childhood lead poisoning.

The threats to our nation’s health are real and come in different forms and in different ways. Public health is a quintessential government function; it is part of our infrastructure and needed to keep Americans safe. And public health is a best buy: investments in public health are repaid many times over. The work CDC and our partners do saves lives and money, protects the American people’s health and is good for the country.

J. Nadine Gracia

As a pediatrician whose patients lived in low-income, minority communities, J. Nadine Gracia, MD, MSCE, saw firsthand how factors such as socio-economic status, education levels and lack of access to healthy foods affect minority health. Today in her role as deputy assistant secretary for minority health and the director of the Office of Minority Health at the U.S. Department of Health and Human Services, Gracia is using her experiences to promote programs that will turn the tide on health inequity, such as the Affordable Care Act. Gracia shared with The Nation’s Healththe strides her office has and will continue to make to promote equitable access to health as a priority.

How has your work as a physician influenced your approach to creating national public health interventions affecting U.S. racial and ethnic minority populations?

One of the things that I learned quickly in my practice is how important these broader social determinants of health really impact the health and well-being of the children and families that I served. If you’re caring for poor families struggling to make ends meet or a child who doesn’t have access to high quality education…the mother who has to make the decision between paying the bills and buying medication or taking her child to medical visits, it gives you perspective on some of the challenges that families and certainly children face.

Part of my training as a pediatrician was to do home visits to patients in my practice and it was an eye-opening experience to be able to go to their homes and see the communities that they lived in. To see where, in many cases, they lack access to transportation…where the cost of getting healthy food was certainly a challenge, that provides a great deal of perspective and influences me as I consider and work in developing programs and policies to benefit those communities so that they can truly reach their full potential for health.

Dan Gross

June 21 is ASK Day, a campaign organized by the Brady Center to Prevent Gun Violence and the American Academy of Pediatrics — and supported by APHA — with a simple idea to keep children safe. The idea urges parents to ask other parents one question before sending their children over to play:

“Is there an unlocked gun in your house?” Like APHA, Brady Campaign President Dan Gross believes gun deaths and injuries are a public health issue. On ASK Day, he spoke to Public Health Newswire about how parents can ask the one difficult, but potentially life-saving, question, and how public health professionals play a vital role in preventing gun deaths and injuries.

You, along with APHA, made the case to The Hill that gun violence is a public health issue. How can the public health community make this case to affect policy change?

Too often the "gun violence issue" is looked at as a political or philosophical debate about guns. We believe the key to effecting real policy change is to base the conversation, instead, on the opportunity to prevent the greatest number of gun deaths and injuries and to avoid the temptation to let anything else interfere. The public health community can play a major role by grounding whatever solutions we advocate — policy or otherwise — purely in public health and safety goals and by accepting the burden of demonstrating how the solutions we seek represent significant opportunities to reduce the number of gun deaths and injuries in our nation.

At Brady, we believe the key to doing this is simply to keep guns out of the wrong hands, whether it’s “prohibited purchasers” like convicted felons and domestic abusers, or straw purchasers and gun traffickers who supply the criminal market or unsafe access by kids in the home. We believe the greatest opportunity to make this a safer and healthier nation lies not in the goal of keeping certain guns away from all people, but in the goal of keeping all guns away from certain people — the people it turns out we all agree should not have them.

The public health community can be vitally important messengers to demonstrate that our goal is simply to prevent gun deaths and injuries and to advocate for the solutions that we can prove will help us achieve that goal.

David Heymann

Global infectious disease expert David Heymann, MD, says the spread of the Zika virus and its link to birth defects is "among the most troubling developments of the early 21st century." Heymann, who chairs the World Health Organization’s emergency committee on Zika and is editor of "Control of Communicable Diseases Manual, 20th Edition," APHA’s bible on infection control, recently spoke with Public Health Newswire. He talked about a new Zika chapter that’s been added to the renowned manual, a new online subscription for accessing "CCDM" recommendations and the outlook for controlling the virus.

Beyond Zika, what other communicable disease threats keep you awake at night?

"CCDM-20" chronicles more than 130 infections. Many of them can pose a serious risk to human health, which is why the editorial committee is dedicated to this work, which it does pro bono, and to keeping the manual as current as possible.

Possibly one of the most important known communicable disease threats today is the rapid development of antimicrobial resistance, which makes existing medicines less effective in curing infections. Research and development on new antimicrobial agents has slowed and there are many financial and other obstacles, but there is a rapidly growing global effort to remove these obstacles, as well as an understanding that vaccines also have a role to play.

And then there is the unknown — emerging infections such as Zika and Ebola that catch the world unaware and unprepared, and have the potential to greatly harm human health and national economies.

The good news is, however, that no matter what the threat, countries can be prepared if they continue to develop and strengthen their public health capacity in epidemiology, laboratory diagnosis and risk communication.

Debra Houry

Healthy People 2020 has an objective on preventing fall-related deaths, signaling a need for more health care providers and communities serving seniors to put the issue on their radar screens. As director of CDC's National Center for Injury Prevention and Control, Debra Houry, MD, MPH, talks with The Nation's Health about the consequences of not addressing risk factors for falls and what CDC recommends on clinical and community-based levels to educate the public about falls prevention.

Why do Americans need to be concerned about injury and violence prevention?

Injuries are a leading cause of death in this country. In the first half of life, more Americans die from injuries and violence — such as motor vehicle crashes, falls or homicides — than from any other cause, including HIV, cancer or the flu. Injuries and violence affect everyone, regardless of age, race or economic status. And, in America, deaths from suicide, opioid overdose and car crashes have been going up in recent years. In 2015 alone, injuries and violence led to 214,000 deaths, 2.8 million people hospitalized and 27.6 million emergency room visits.

The economic costs are also staggeringly high. The total lifetime medical and work loss costs of injuries and violence in the U.S. was $671 billion in 2013.

Freeman Hrabowski

From his days as a child leader in the civil rights movement in Birmingham, Alabama, to his work supporting young minorities’ interests in science, technology, engineering and math fields, Freeman Hrabowski, PhD, MA, has spent most of his life advocating for equitable opportunities — especially in higher education. He will keynote the opening session of APHA’s 143rd Annual Meeting and Exposition on Sunday, Nov. 1, in Chicago. Hrabowski talked with The Nation’s Health about the importance of increasing minority participation in science-related fields and the consequences of inaction.

Why is it important for underrepresented students to pursue STEM careers? What barriers stand in the way?

There are several reasons that come to mind. Number one, many of the jobs available today and in the future require backgrounds in STEM areas and much of our economy depends on the STEM infrastructure in our country. At the same time, an increasing proportion of the American population consists of people from minority groups. And unfortunately, right now, too few minorities are entering those careers.

Yassine Kalboussi

Legacy International professional fellow in non-profit development Yassine Kalboussi, a native of Tunisia, spent a month at APHA headquarters to both learn about the U.S. public health system and how to advocate for bolstered public health services in his home nation.

How do you hope to revolutionize public health in Tunisia?

My take-home message is that we have a group of nine to 10 people in Tunisia — junior doctors, one graphic designer, one IT manager — and we started a small NGO called “Public Health Tunisia.” First of all, we’re helping with capacity building and we will have our first training in September; it’s about health in all policies.

We have two major challenges. First, we want to have people with backgrounds other than in medical studies: people from education, media urban studies. Then the second challenge is how to follow up with this training. So we will get a series of training with WHO expert or other experts.

Our mission is to advocate for better public health training in Tunisia. We do not have a public health school in Tunisia or any public health training. And I think this motivated group could develop the idea and mission and vision for the development of our own professional and academic careers. The name is big; we will start with small projects and capacity building, and hopefully going through our public health lives our new baby will grow up with public health academic careers.

David Kitchen

The Nation’s Health spoke to David Kitchen, PhD, associate professor of continuing studies at the University of Richmond and author of "Global Climate Change: Turning Knowledge Into Action," about what extreme weather events mean for environmental and public health, and how people will be forced to adapt to an increase in such crises.

What role do scientists have in communicating the effects of climate change and making the connection between climate change and extreme weather events?

Ten years ago, I’d have said the scientists just need to present the evidence and the logical community would come to the conclusion they needed to do something. Scientists should be informing policy makers and educating the public. We should be trying to communicate about the issues of climate change.

Faisal Khan

The high-profile turmoil in Ferguson, Missouri, following the death of Michael Brown last August not only made international headlines; it impacted the health of the entire city. Public Health Newswire talked to St. Louis County Department of Public Health Director Faisal Khan about the events in Ferguson, how the public health department responded to the city’s unique health needs in time of crisis and how the incidents have sparked a sea change in the way public health is conducted in St. Louis County.

St. Louis County recently experienced high-profile protests and civil unrest stemming from a range of inequities. Health is certainly one of them. How did your department respond to this unrest?

If you've been familiar with the St. Louis area for the last year or so we’ve been in the news for a lot of the wrong reasons. And my challenge to all our staff after I was appointed to this position was, “OK, so you’ve observed what’s been happening in Ferguson. You’ve observed all the public unrest. What public health engagements do you think we ought to have been involved with in past years that we’ve missed and where do you think we should be plugged in now, as of yesterday?” And everybody sort of looked at me and said, you know, “What do you mean? We’ve got all these great health centers, three of them. We provide primary and specialty care services. We do disease investigations and restaurant inspections and building permits and milk inspections and water inspections.”

And I said, “No, no, no. Set that aside.” What you see in Ferguson and neighboring areas are communities under a toxic amount of stress that has built up over decades as a result of gentrification, urban renewal — and all of those are sort of code words for socio-demographic changes. But [we’ve got] issues such as concentrations of poverty, unemployment, youth disenfranchisement, perceived or real injustices by municipal police department to the point that it leads to high incarceration rates, failing school systems, the lack of safe and walkable communities and recreational facilities.

All of those add up to create a toxic level of stress and when it exploded in this expression of anger, people were shocked and I, as a public health professional, was shocked that they were shocked. Because if we had our fingers on the pulse of the community for the last decade or so, or even earlier, this would not have been a shock to us. It would not have been surprising. Ferguson was just a symptom of what is happening in the northern part of St. Louis County. We see it happening in Baltimore, we see it happening in Cleveland and other metropolitan areas. So I’m not in a club of one. Unless we get plugged in at the ground level in addressing a lot of these concerns we’re not going to be able to make a difference. We can sit in our offices and keep talking about public health interventions and excellent programs until the cows come home. It won’t actually make a difference in terms of improving the measurable health outcomes that we desire to see...

Boris Lushniak, MD, MPH

Acting Surgeon General Boris Lushniak, MD, MPH, says Americans need to pay better attention to protecting their skin. Skin cancer, he says, is a year-round threat. Lushniak will join former surgeons general for a discussion of the future of health in America at APHA’s 142nd Annual Meeting and Exposition at 4:30 p.m. on Monday, Nov. 17, in New Orleans. First, he answered some questions about his skin cancer awareness campaign and what we all can do to help.

The call to action has five goals. What is your office doing to make those goals a reality?

The call to action is not just the office saying, “Here is what we’re going to do.” In reality, we turn to everyone out there, to all aspects of society. I turn, yes, to the federal family, to the government, to legislators. But I also turn to the individuals. I turn to schools. I turn to businesses, to employers.

An example is that in the call to action we really go out to all the schools across the United States, saying “Listen, look at what you are exposing your children to potentially during the day with outdoor recess.” Outdoor recess is very important. We want kids to be outdoors. But can you begin looking at the idea of shady areas? Can you begin looking at the concept of having kids allowed to wear hats when they’re outdoors? To allow them to apply sunscreens onto their skin to protect them from ultraviolet radiation? Have you looked into the idea of timing outdoor recess at a time period where the ultraviolet radiation isn’t at its highest?

People who are employers of outdoor workers: Do you have break areas where the workers can be under shade? Are the workers allowed to wear protective clothing and use sunscreen on the job? Are you part of this mission to decrease the health effects of ultraviolet radiation on you, on your workers and on your business?

Ed Markey

Each year APHA bestows its Distinguished Public Health Legislator of the Year Award on one local, state or federal lawmaker who has demonstrated leadership in protecting public health programs and funding. This year’s award winner is U.S. Senator Ed Markey, D-Mass. Markey spoke to Public Health Newswire about what the award, and public health, means to him, along with his thoughts on climate change, opioid overdose and why the Affordable Care Act represents “one of the proudest” moments of his career.

Congratulations on the award, Senator Markey. You’ve been a champion on important public health issues for nearly 40 years. What does public health mean to you, and how can legislators like you help us create the healthiest nation in one generation?

Thank you very much. I am deeply honored to receive this award. Public health to me is all inclusive — it means everyone. Not only should we focus on health care providers and hospitals, but we should also be concerned about access to public parks, healthy foods and employee wellness programs. When it comes to public health we have made some significant progress in recent years. Thanks to the Affordable Care Act, millions more people have health insurance now than ever before. Life expectancy has grown. Cutting-edge research is being conducted across the country to continue our exciting progress in both treatment and prevention procedures. And the Obama administration has turned the spotlight on nutrition and exercise education and programs, especially targeted at children.

A new study from the American Journal of Public Health looked at whether changes to warning messaging could help deter young women from indoor tanning. To learn more, Public Health Newswire checked in with lead researcher, Darren Mays, PhD, MPH, to take a deeper look at tanning, skin cancer and how communication might assist with prevention. Mays, who is with Georgetown University Medical Center and the Lombardi Comprehensive Cancer Center, is also a former chair of APHA’s Student Assembly.

Q: Tobacco products are required to carry warnings that inform consumers about the risk of smoking. Is there anything we can learn from those in the context of indoor tanning?

A: The research on tobacco product warning labels shows that warnings with vivid visual imagery and text that convey the risks of tobacco use are more effective than text-only warning labels. Currently, text-only warning labels are required for indoor tanning devices, including tanning beds and tanning booths. Consistent with the research on tobacco warning labels, our study suggests that indoor tanning device warning labels that use vivid imagery and persuasive text to communicate the risks of indoor tanning could be more effective than the currently required warnings.

Gina McCarthy, MS

When Environmental Protection Agency Administrator Gina McCarthy, MS, announced EPA's Clean Power Plan on June 2, the proposal was met with support from the public health community. The plan, part of President Barack Obama's Climate Action Plan, would cut carbon pollution from existing power plants by 30 percent by 2030. The plan is estimated to lead to 150,000 fewer asthma attacks per year and an 8 percent reduction in electricity bills. EPA is accepting comments on the plan until Dec. 1. McCarthy took the time to answer some questions about the plan and EPA's goals of making the air Americans breathe better.

You're focusing a big portion of EPA's efforts on power plants, through the Clean Power Plan. Why power plants, and why now?

Today, about one-third of America's carbon pollution comes from power plants. But right now, there are no national limits to the amount of carbon pollution that existing plants can pump into the air we breathe. We limit the amount of toxic chemicals like mercury, sulfur and arsenic that power plants put into our air and water. But they can dump unlimited amounts of carbon pollution into the air. It's not smart, it's not safe and it doesn't make sense.

Climate change endangers our health and safety. Warmer temperatures mean longer allergy seasons, more smog leading to more asthma and respiratory problems and growing zones for disease vectors like mosquitoes. And 2012 was the second-most expensive year in U.S. history for natural disasters.

This proposal is about protecting our health, our economy and our children's future.

Read the full Q & A in the November/December issue of The Nation's Health.

Alfredo Morabia

In January, Alfredo Morabia, MD, PhD, MPH, MHS, was named the next editor-in-chief of APHA’s American Journal of Public Health. Morabia, a renowned epidemiologist who has worked around the globe, will bring a new voice to the journal, which has been helmed for the past 16 years by Mary Northridge, PhD, MPH. As a public health advocate, he had lots to say to The Nation’s Health about his upcoming editorship.

The big goal that APHA is focused on right now is making the U.S. the healthiest nation in one generation. How do you think AJPH and APHA can work together on that?

First of all, I think being related to APHA is a great asset for the journal. It’s a terrific asset, because it’s got access to a large audience of people who have expertise in different domains who are following the policy, who know what’s coming up and what’s needed and connections with people who actually make the policy.

I think there’s a lot to learn from the members of APHA. And this interaction should go both ways. The journal can generate the information on the topics of major interest. And I see this also as a very dynamic and enriching dialogue between APHA and the journal. It’s really very important for me.

I think the journal can help reach that goal of the healthiest nation in one generation for several reasons. It’s a great goal. It needs to be supported by evidence. And this is what the journal does. It carries the best research and brings it in a traditional way to the attention and the usage of those who are involved as practitioners, working in communities, involved in health (advocacy).

There's something brilliant about the goal of the healthiest nation in one generation, something I like very much. We cannot become healthier alone.

We need to hurry up because one generation is tomorrow. It’s very soon. So to reach that, we need to build and (learn from) experiences that exist worldwide.

Charlotte Parent

No longer applying bandages to problems that only get worse, the New Orleans Health Department is working to address social determinants of health, the roots of many public health issues in the Crescent City. Taking a neighborhood-by-neighborhood approach, Director Charlotte Parent told The Nation’s Health about how she and her team are working to make their communities healthier and stronger than ever before.

What lies ahead for the health department and health in New Orleans?

We are working on our programs that we put in place to ensure that they stay here. But, we are also focused on health equity. That’s our latest initiative that we have in place. As an accredited health department, we’ve been trying to figure out how do we take our staff forward to understand what equity is.

It wasn’t only about how we bring new initiatives. We want to make sure that whatever we’re putting forward is touching everyone in the way that will be the most effective for everyone. For those that need more, we’re making sure that we do that. Those who maybe not need as much, we’re also touching them, too.

So, equity is our next stand. And hopefully in the next couple of years you’ll hear more about New Orleans around health equity, and equity in general.

Charlotte Porter

When Charlotte Porter, MPH, took over as deputy director of the Federal Emergency Management Agency’s Individual and Community Preparedness Division early this year, she already had preparedness in her sights for years. The former director of the office of FEMA’s National Advisory Council, Porter has seen the importance of preparedness played out during many local and national emergencies. As September is National Preparedness Month, Porter spoke with The Nation’s Health on the importance of being ready in case of disaster.

When we talk about preparedness, what are we talking about? What is it that we need to be prepared for?

Americans need to be prepared for really any and all potential hazard or disaster that they may be susceptible to. We have found that nearly 60 percent of American adults have not yet practiced on what to do in a disaster by participating in a drill or a preparedness exercise at work, home, or school in the past year.

And that’s really the whole point of America’s PrepareAthon!, which is a grassroots campaign to not only educate and bring awareness to individuals and communities, but also to encourage them to take action with the education that they receive so that we build a muscle memory of sorts to increase the nation’s preparedness and resilience at the individual level.

Cecile Richards

Planned Parenthood President Cecile Richards will be the opening keynote speaker at APHA's 2016 Annual Meeting, and she said there is much for public health advocates to be proud of — and more work still to be done

What are some recent victories for Planned Parenthood and public health, and what battles do we still need to fight?

We just had the recent Supreme Court decision, which of course struck down some of Texas’ new abortion restrictions. It’s impossible to overstate the importance of this decision not only for people in Texas, but now for people all across the country. The court really recognized that the laws that were passed in Texas under the guise of helping women in fact did just the opposite. What we’ve seen since that decision is that restrictions in six states have already been stopped. It has absolutely made a huge difference in particularly some of those states, like Mississippi and Alabama, where we’ve been a health care provider for a long time. These are states where there is very little access to safe and legal abortion as it is.

There are still enormous barriers to women to access safe and legal abortion, particularly for women who are low-income, for women who live in parts of the country that have legislatures and/or governors that have been unfriendly to their rights, and so there is a ton of work left to do.

I think the other big victory that has happened in the last few years was of course the Affordable Care Act, which writ large was probably the single biggest piece of progress for women’s health that I can remember...

I’d say probably the biggest challenge that we are focused on at Planned Parenthood, we are really focused on creating health care equity in America. Even as we make progress on types of medicines, availability, insurance coverage, we are seeing still enormous inequity in the ability to access this care. Women of color, immigrants, LGBT people are disproportionately impacted by restrictions on health care access. And for too many people, birth control services, transgender services, abortion services are out of reach because of folks’ income or because of where they live or because of just the environment or, frankly, their employer. There are other issues that are related — including maternal and infant mortality, rates of unintended pregnancy, prevalence of HIV infection, STDs — that people of color experience in disproportionate numbers.

It is unconscionable that so many people are going without health care. We have to do more as a country. That is really I think our biggest call to action.

Griffin Rodgers

More than 20 million Americans may have lab tests showing kidney disease, and rates are growing among adults. Kidney damage can cause waste to build up in the body, and is linked to heart disease and other health problems. In advance of March’s observance of National Kidney Month, The Nation’s Health spoke with Griffin Rodgers, MD, MACP, director of the National Institute of Diabetes and Digestive and Kidney Diseases, about kidney disease risks and steps for prevention.

Who is at greatest risk for kidney disease and why?

People at greatest risk for chronic kidney disease, or CKD, are people who have diabetes, high blood pressure, cardiovascular disease or a family history of kidney failure. Diabetes and hypertension, at least in this country, are the leading causes of kidney damage. Nearly 1 in 4 people with diabetes has CKD, while about 1 in 5 with hypertension has CKD.

Research also shows that there’s a correlation between heart disease and kidney disease. People who have cardiovascular disease are at higher risk for developing kidney disease. Conversely, people with kidney disease are at a high risk for developing cardiovascular disease.

Jamie Roquest

Tens of thousands of residents have been affected by flooding in southern Louisiana, and Jamie Roques, MPA, MPH, APRN, is on the front lines of the public health response as a member of the state’s Disaster Medical Assistance Team. Roque — a member of APHA’s Council of Affiliates and member and Affiliate Representative to the Governing Council for the Louisiana Public Health Association — spoke to Public Health Newswire about what took place, the public health response, and how APHA can both help relief efforts now and prepare for health emergencies in the future.

The Baton Rouge floods continue to threaten the health and wellbeing of hundreds of thousands of people. How has public health supported affected families in its aftermath?

Affected families are way too overwhelming for the public health workforce in the area to address alone. It is estimated that 60,646 homes were damaged and approximately 30,000 people were rescued. With heavy hearts we did report 13 flood-related deaths to date. Ezra Boyd, who holds a PhD in geography from Louisiana State University, said that as many as 188,729 occupied houses and 507,495 people — 11 percent of the state’s population — were "affected" by the flood.

I know the public health community has worked through churches, nonprofit organizations and social media sites to help others in need, including donating; purchasing and sorting personal care items and clothing; collecting household cleaning supplies and other demolition materials for sheet rock and insulation removal; volunteering to wash clothing for neighbors, friends and families; and cooking hot meals for the workers.

Basically whatever the call, people are ready and willing to help. I am not involved in the environmental response but I know it is massive. There have been some water boil advisories issued to consumers in affected communities. Another major concern in many communities is mold in homes and its effects on those exposed to it.

As of Aug. 23, many people returned to work at the public health units and started providing their usual services to those in need. A mobile team of mental health professionals from the Louisiana Department of Health, Capital Area Human Services District have been going to the general population shelters doing assessments and trying to identify those who would benefit from psychiatric evaluations and professional counseling.

Mark Rosekind

Mark Rosekind, PhD, serves as the 15th administrator of the National Highway Traffic Safety Administration. On the job for more than a year and a half, Rosekind has led NHTSA in its work to improve both vehicle safety and driving safety. Recently, that work has included addressing behavioral change to improve safety for both drivers and pedestrians. The Driving Behavioral Change in Traffic Safety Summit, held in March in Washington, D.C., served as a platform to begin advocating for Americans to take small steps to keep themselves safe, as well as improve the safety of their communities. Rosekind shared his insight with The Nation’s Health shortly after the summit.

What’s coming up for NHTSA that the public health community can help engage in?

Almost a year ago, we identified drowsy driving as a new initiative, and so this coming year we’re going to have a variety of activities that roll out throughout this year focused on drowsy driving.

And the other thing I would just say is that based on our five regional summits, we are going to gather everybody back up in the fall, have a meeting, talk about the near-term kinds of activities that all of us can engage in to help address the lives we need to save and also take a look at the future and think about, “What would a 25-year vision look like if we had no deaths on our roadways?”

And I think that’s a scenario we’d all like to envision, but it’s going to have to be a very different world than the one we live in right now.

Jim Skiera

International Society of Arboriculture Executive Director Jim Skiera says the relationship between the public health and urban forestry community is “in its infancy,” but that opportunities abound to collaborate for greener communities and a resulting healthier America. Public Health Newswire talked to Skiera, also an executive board member of i-Tree and founding chair of the Sustainable Urban Forests Coalition, about this potential.

APHA has long promoted for sound public health policy in our design of cities. According to APHA Executive Director Georges Benjamin, “public health and urban planning have had a long and very productive relationship.” Can the same be said for public health and urban forests?

In truth, the relationship between the public health community and the urban forestry community is in its infancy, but it is growing and getting stronger. This is partially because there is now increased awareness of urban ecosystems – a term that wasn’t even used a few decades ago – and the integral role urban and community forests play in improving human health in all communities, from rural towns to megacities. We have made a connection with the urban planning community, and all sides recognize the direct connection between the human health benefits that urban and community forests provide. Specifically, research findings on the social and health benefits of urban forests are capturing the attention of public health officials on a global scale.

Mary Wakefield

Mary Wakefield, PhD, RN, has served as administrator of the Health Resources and Services Administration in the Department of Health and Human Services since 2009. In that time, she has seen major changes in how Americans see and address their health, from millions of people getting health insurance for the first time to the expansion of health clinics in both rural and urban populations. She also presented at APHA’s 142nd Annual Meeting and Exposition in November in New Orleans. Wakefield spoke with The Nation’s Health about how she hopes public health advocates can take their communities’ health to the next level.

Looking at the future of public health through HRSA — how do you see the public health landscape evolving?

The focus of our work at HRSA is really to support access to quality health care services, primarily for vulnerable populations. Those can be people or families that are financially vulnerable — low-income families, for example. They are folks who are medically vulnerable. There are folks that are geographically vulnerable. That’s a challenge, by the way, not just for some of our rural communities, but a challenge for some of our urban areas, inner-city areas, as well.

In terms of integrating public health, we deploy our resources at HRSA with a close eye on how we can achieve health equity and improve health outcomes. We do that both through investments in primary care, but also in public health. We integrate public health in our work by aligning public health orientation with primary care.

The journeys of Gladney, Foster and Starling are the core of Pulitzer Prize-winner Isabel Wilkerson's book “The Warmth of Other Suns: The Epic Story of America’s Great Migration.” Wilkerson, keynote speaker at the opening general session of APHA’s 142nd Annual Meeting and Exposition in New Orleans, explains why we all should know more about this important slice of U.S. history.

Why is it important for public health workers to have an understanding of this history?

It’s vital that public health workers have an understanding of this history because it’s understanding the history that helps you understand the patient. Every person that comes before anyone seeking help is not just the person they see before them. They are in some ways a compendium of the history of all that’s gone before them and even in succeeding generations. How they appear to themselves up to that moment, how they perceive the possibilities of the treatment, how and whether they are willing to follow the instruction of the health care professional, all has to do with the history that they bring into that room. And the skepticism, the fear, the tentativeness, the wariness — all of those things come into play when a patient is there with the health care professional seeking treatment.

Madieu Williams

Madieu Williams played nine years in pro football for the Cincinnati Bengals, Minnesota Vikings, San Francisco 49ers and the Washington Redskins. In 2005, he created the Madieu Williams Foundation to improve education, health and fitness for underprivileged youth both in the United States and in his native Sierra Leone. In January, the National Association of Distinguished Professionals named him its executive of the year member for excellence in nonprofit.

While the Ebola outbreak swept through West Africa this summer, Williams, his foundation, and University of Maryland-College Park students and faculty traveled to Sierra Leone to provide support. Additionally his foundation set up an Ebola relief fund to provide food and essential resources to families in Sierra Leone communities, raising more than $6,000 in two months.

Public Health Newswire caught up with Williams to talk about his experiences and why “partnerships are everything.”

APHA aims to create the healthiest nation in one generation by 2030, and one of our guiding priorities is to improve public health infrastructure and capacity. Your foundation focuses on partnerships to get this done. What is the importance of partnerships in public health, and how does your foundation build them?

Partnerships are crucial because no one man is an island. We all need each other to work cooperatively. For instance this summer, we brought the Maryland engineering team to Sierra Leone and they installed hand-washing stations for students (editor’s note: engineering students also laid the foundation for a secondary school). It’s so important to have partners. This is our (foundation’s) first year partnering with the Maryland School of Public Health because we need to provide more educational resources and more training regarding public health issues surrounding the world and communities we live in. And we have global and community partnerships, from Sierra Leone to things we do in Prince Georges County (Md.).